1. An Arthritis Foundation Nurses’/ Providers’ Toolkit for RA: For the Early Detection & Treatment of Rheumatoid Arthritis American Public Health Association Annual Conference in Chicago Tuesday, November 3, 2015

3. Juvenile Arthritis Help & Support Research Advocacy Arthritis Foundation Four Pillars

4. 1.5 million Americans 250,000 in NY, NJ and Eastern PA Impact and Damage to Joints Loss of Movement Decreased Ability to Work Increased Medical Costs if not treated early Affects lives on different levels; physical, social, psychological, financial Background on Rheumatoid Arthritis

5. Overview of the Toolkit The AF, NE in partnership with nurses and nurse practitioners, created A Nurses’ Toolkit for RA Contains 13 evidence-based RA diagnostic and treatment aides: existing best practices, vetted information, and resources Tool is digitally accessible by healthcare providers in various areas including underserved settings In 2014, a prototype of the Toolkit (available as a downloadable PDF) was completed and piloted at major institutions in NY Since Q1-2015, the 1st half of the Toolkit is being developed as a digital InfoSite/app by WebMD’s Medscape

6. Goals of Early Diagnosis & Aggressive Treatment Slows progression Limits joint damage Allows for more active living EULAR study shows NE lags on timely treatment

7. Nurses’/ Providers’ Toolkit for RA Bridges gap in RA diagnosis & patient care Aggregates evidence-based tools Scalable and easily accessible Available via desktop, smartphones & tablets Wide range of clinical settings Promotes coordinated care

8. Preliminary Research with Patients & Healthcare Providers Identifies these & other roadblocks to treatment 1 st HCP seen is often PCP, not rheumatologist PCPs and others not as familiar with best practices and optimal treatment Patients often confused by diagnosis Recommended protocols may be intimidating and less than optimistic Assessment of Needs

9. Objectives Toolkit is currently available in a PDF format, with: - hyperlinks to checklists - videos - peer-reviewed journal articles - medical websites to the sites conducting the six-month pilot Toolkit was tested for usability (piloted) in 3 sites & revised by 3 additional sites Was edited to refine existing elements and add or eliminate features Is being developed an online interactive website and app for desktops, tablets and smart phones for release by 4 Q of 2015 Marketing plan to promote to medical community - Ads through Medscape - Presentations at medical/health industry meetings - Others TBD

10. Learning Objectives Identify and screen for the top three most common co- morbidities in 50+ rheumatoid arthritis patients by the second year of the Toolkit’s launch. Differentiate RA from the other 100+ rheumatic diseases by the second year of the Toolkit. Discuss the needs, goals and clinical gaps in the treatment of RA by the second year of the Toolkit.

11. Target Learner Audience To be used in a variety of healthcare settings; including underserved communities by wide range of healthcare providers

12. Study Design Qualitative Study Designs 1 Focus group with 4 nurses “case managers” (2 from PA State Pilot Program, 2 independent Blue Cross telephonic program) 1 Focus group with 6 practicing nurses 3 Individual nurse in-depth interviews 1 Focus group with 5 RA patients 1 Individual patient in-depth interview

13. Methods

14. Innovations  We assured that the project idea was original and did not duplicate existing projects by: Having market research firm conduct thorough audit of RA support websites and programs offered by pharmaceutical companies, not-for-profit organizations, university medical centers & informational sites to identify nurse/patient programs offered. Conduct focus groups with nurses to discuss what they perceived as their role in treating patients with RA, what resources were currently being used to treat patients with arthritis, what they felt worked well, and what their needs were to provide efficient care for patients with RA. Having Nurses’ Advisory Committee to aggregate the best existing RA diagnosis and treatment information into one comprehensive guide. Medical writer & nurse clinical editor developed toolkits for the diagnosis and treatment of other diseases, including Alzheimer’s.

15. Outcome Evaluation The success of the Toolkit will be measured through feedback from the healthcare professionals using it, including: Numbers reached through promotion and marketing to nurses, nurse practitioners and other healthcare providers Digital metrics/analytics, such as visits to the site, click- through rate, length of time on site, number of tools downloaded, etc. Ongoing online survey feedback from users Final consensus meeting with Nurses’ Advisory and Content Development group.

16. Dissemination Plan  Will be introduced to the medical community, including promotions to: Online medical resource sites Ads through Medscape Presentations at medical/health industry meetings Others TBD

17. Project Timeline Jun– Nov 2014 - Toolkit pilot tested in 3 sites & reviewed by 3 additional sites Dec 2014 – January 2015 - Feedback and surveys collected from nurses at 3 pilot sites Feb 2015 - Contract with digital company Feb 2015 – March 2015 – Finalize Toolkit contents Apr 2015 – August 2015 - Digitalize Toolkit for online use Nov-Dec 2015 - Launch and market Toolkit (Section 1) Dec 2015 - Completion of Toolkit is dependent upon future funding (Section 2)

18. Table of Contents

19. Results June 2014- pilot version with downloadable tools was launched and pilot-tested in 3 clinical settings which included 13 tools Feedback was analyzed after the pilot phase was completed in November 2014 Format was enhanced to redesign Toolkit as an info-site/app for the expected launch date of Nov-Dec 2015 Expected long-term outcomes will include lower disease activity, improved rates of remission, decreased hospitalizations and improved quality of life

20. Nurses’/Providers’ Toolkit DESKTOP VERSION

21. SMARTPHONE APP